Food insufficiency and American schoolaged children’s cognitive, academic and psychosocial development. Pediatrics

ABSTRACT. Objective. This study investigates associations between food insufficiency and cognitive, academic, and psychosocial outcomes for US children and teenagers ages 6 to 11 and 12 to 16 years. Methods. Data from the Third National Health and Nutrition Examination Survey (NHANES III) were analyzed. Children were classified as food-insufficient if the family respondent reported that his or her family sometimes or often did not get enough food to eat. Regression analyses were conducted to test for associations between food insufficiency and cognitive, academic, and psychosocial measures in general and then within lower-risk and higher-risk groups. Regression coefficients and odds ratios for food insufficiency are reported, adjusted for poverty status and other potential confounding factors. Results. After adjusting for confounding variables, 6-to 11-year-old food-insufficient children had significantly lower arithmetic scores and were more likely to have repeated a grade, have seen a psychologist, and have had difficulty getting along with other children. Food-insufficient teenagers were more likely to have seen a psychologist, have been suspended from school, and have had difficulty getting along with other children. Further analyses divided children into lower-risk and higher-risk groups. The associations between food insufficiency and children's outcomes varied by level of risk. Conclusions. The results demonstrate that negative academic and psychosocial outcomes are associated with family-level food insufficiency and provide support for public health efforts to increase the food security of American families. Pediatrics 2001;108:44 -53; hunger, food insecurity, food insufficiency, poverty, psychosocial development, cognition, children, NHANES III. ABBREVIATIONS. NHANES III, Third National Health and Nutrition Examination Survey; WISC-R, Wechsler Intelligence Scale for Children-Revised; WRAT-R, Wide Range Achievement TestRevised; PIR, poverty index ratio. A lthough they live in a wealthy nation, children in the United States are not immune to poverty and hunger. Almost 1 in 5 American children are poor, and Ͼ14 million children under age 18 live in food-insecure households, in which there is a limited or uncertain availability of nutritionally adequate or safe foods. 1,2 Although these numbers demonstrate the magnitude of this social problem, they do not adequately express the real burden of food deprivation for American children. Research on child development in nonindustrialized countries shows that malnutrition is associated with delays in motor skills, cognitive deficits, and decreases in school performance. METHODS NHANES III Data Data for children ages 6 to 11 years (n ϭ 3286) and 12 to 16 years (n ϭ 2063) were analyzed from the Third National Health and Nutrition Examination Survey (NHANES III), a cross-sectional representative sample of the US civilian noninstitutionalized population living in households (homeless people were not included). The survey was conducted from 1988 to 1994. Mexican Americans and black Americans were oversampled to provide more reliable estimates for these groups. Detailed descriptions of the sample design and operation of the survey have been published elsewhere. 44 PEDIATRICS Vol. 108 No. 1 July 2001 in the mobile examination centers, and blood samples collected in the mobile examination centers. Of the proxy respondents, 89% were mothers and 6% were fathers of the child; the rest were other relatives or caregivers familiar with the child. All interviews were administered using standard protocols by trained interviewers. 9 Theoretical Model Using past research, a theoretical model of the ecological factors affecting school-aged children's cognitive, academic, and psychosocial development was created using variables available from NHANES III. 10 -21 We postulated that poor cognitive, academic, and psychosocial outcomes are caused by deficiencies in family and child resources, environmental risks, past nutrition, health, and social risks, and family food insufficiency. The variables used to test this model and their age group availability in NHANES III are shown in Food insufficiency has been previously shown to be negatively associated with children's health status after adjusting for these other factors. Cognitive, Academic, and Psychosocial Outcomes Cognitive functioning was assessed using 2 subtests of the Wechsler Intelligence Scale for Children-Revised (WISC-R): Block Design, a perceptual organization examination in which children are asked to construct designs out of blocks to match a model; and Digit Span, a freedom-from-distractibility examination in which children are asked to repeat up to 8 digits in forward and reverse directions. Psychosocial outcomes included the number of days the child had been absent from school in the previous year, whether the child had ever seen a psychiatrist, psychologist, or psychoanalyst for any emotional, mental, or behavioral problems, whether the child had ever been suspended from school, the number of good friends the child had, whether the child had difficulty getting along with other children or teenagers, and whether the child was somewhat shy and slow to make a new friend. Sociodemographic Data and Family and Child Resources For each child in the survey, information about sex, age, raceethnicity, health insurance status, family size, number of rooms in the family residence, number of times the family had moved, metropolitan or nonmetropolitan region of residence, family income, whether they had a regular source of health care, and employment status and education of the family head were provided by a responsible adult living in the home. The family head was a person who owned or rented the home where the child lived. Total family income for the previous 12 months was reported for categories ranging from Ͻ$1000 to$80 000 and over, in $1000 increments below$19 999, in $5000 increments between$20 000 and $49 999, and in$10 000 increments between $50 000 and$79 999. A poverty index ratio (PIR) was then calculated by comparing the midpoint of the category and the child's family size with the federal poverty line. 26 These analyses used 3 poverty status categories: low income (PIR Յ 130% of the poverty line, which is the federal cutoff point for eligibility for the Food Stamp Program), middle income (Ͼ130% to 350% of the poverty line), and high income (Ͼ350% of the poverty line). A child was defined as insured if she or he was covered during the last month by private health insurance, military health care insurance, or Medicaid and if the coverage paid for more than accidents. Twelve percent of the WISC and WRAT subtests were conducted in Spanish; therefore, for these analyses we controlled for the language in which the test was conducted. For analyses of WRAT and WISC scores, information on race, ethnicity, and the language used during the proxy interview was used to classify children into 4 race-ethnic categories: all non-Hispanic white children and other children with cognitive tests conducted in English, all non-Hispanic black children, Mexican-American children with cognitive tests conducted in English, and MexicanAmerican or other children with cognitive tests conducted in Spanish. For analyses of other outcomes, we controlled for language by creating the same categories with the main language the child spoke at home. Food Insufficiency For the purpose of the NHANES III survey, food insufficiency was defined as "an inadequate amount of food intake due to a lack of money or resources." A child was classified as food-insufficient if the respondent to the family questionnaire reported that the family either sometimes or often did not get enough food to eat. This question has undergone cognitive testing Environmental Risk For all children, the child's blood lead concentration was measured (in micrograms per deciliter). Family size was divided by the number of rooms in the family residence to determine a continuous measure of crowded housing status. Past Health, Nutrition, and Social Risk For children 6 to 11 years, information was collected on the mother's age at birth, the presence of birth complications, low birth weight (birth weight below 2500 g), and any prenatal smoke exposure. A child was classified as having attended childcare if he or she had ever attended childcare where there were 6 or more children before he or she was 4 years old. We used height (in meters) measured at the time of the examination as an indicator of past nutrition status. Health Status Proxy-reported health status provides a general summary of children's health. Proxy respondents for the household youth questionnaire were asked to describe the child's health as excellent, very good, good, fair, or poor. For this analysis, the fair and poor categories were combined because Ͻ1% of children were reported to be in poor health. Statistical Methods Data for children 6 to 11 years of age and teenagers 12 to 16 years of age were analyzed separately. Using the theoretical model as a guide, the analyses were conducted in 4 stages. First, main effect linear regression models (for continuous outcomes) or logistic (for dichotomous outcomes) or ordinal logistic (for ordinal outcomes) regression models were created to test the hypothesis that food insufficiency is associated with cognitive, academic, or psychosocial outcomes, independent of other potential confounders. All variables in the theoretical model were included in the regression models and included the variables shown in The third stage of the analyses created a risk factor index. Previous research has shown that risk factors affect children's cognitive, academic, and psychosocial performance in an additive fashion. The fourth stage of the analyses looked for interactive associations. The risk indices allowed the children to be divided into 2 categories: lower risk (0 -2 risks) and higher risk (3 or more risks). Regression models were created to assess the relationship between food insufficiency and the outcomes within each risk category. In these models, PIR, education of the family head, height, and WISC scores (for academic outcomes) were entered as continuous control variables and sex, age, metropolitan region, and race-ethnicity as categorical control variables. Interactions between food insufficiency and PIR, race-ethnicity, and education of the family head were also assessed and found not to be meaningfully significant. Sample weights were created for the NHANES III data to account for the oversampling of certain groups, such as black Americans and Mexican Americans, as well as nonresponse. For all analyses, NHANES III weighted data were analyzed using the svy commands available in Stata Statistical Software. For prevalence estimates and means, missing data were excluded from the analyses. For the regression analyses, all missing data except food insufficiency status were imputed using the impute command in STATA, which uses regression equations to fill in missing values based on other nonmissing data in the child's record. Variables included in these regression equations were chosen separately for each imputed variable using backward stepwise regression to screen for associated variables. For dichotomous variables, impute was used to predict a probability, and a random value was selected based on this probability. The number of missing values imputed ranged from 0 children missing data for whether the child had a regular source of health care to 255 6-to 11-year-old children and 176 teenagers missing data for their family's poverty index ratio. A total of 336 6-to 11-year-old children and 450 teenagers had at least 1 missing value. RESULTS Unadjusted Means and Prevalence Estimates Unadjusted mean scores and percentages for cognitive, academic, and psychosocial outcomes are shown for food-insufficient and food-sufficient children in Food-insufficient children and teenagers were also more likely to have psychosocial difficulties than those who were food-sufficient. For teenagers, these differences were dramatic: Food-insufficient teenagers were more than twice as likely to have seen a psychologist, almost 3 times as likely to have been suspended, almost twice as likely to have a lot or some difficulty getting along with others, and 4 times as likely to have no friends. Regression Analyses Results of the main effects regression analyses for the relationships between food insufficiency and the outcomes controlling for other characteristics are shown in Food-insufficient teenagers were almost twice as likely to have seen a psychologist, have been suspended from school, and have difficulty getting along with other children as food-sufficient teenagers. Food insufficiency was not significantly related to any of the cognitive or academic outcomes. The effect of food insufficiency for these outcomes was only slightly attenuated by the addition of health status in the model, which suggests that if the association between food insufficiency and the outcomes was causal, the effect of food insufficiency on 46 FOOD INSUFFICIENCY AND CHILDRENЈS DEVELOPMENT these outcomes did not act primarily through diminished health status (see Risk Factor Indices Food insufficiency is not the only risk factor many American children face. The number of risk factors a child had was plotted against his or her academic, cognitive, and psychosocial outcome

Project FIT: Rationale, design and baseline characteristics of a school- and community-based intervention to address physical activity and healthy eating among low-income elementary school children

<p>Abstract</p> <p>Background</p> <p>This paper describes Project FIT, a collaboration between the public school system, local health systems, physicians, neighborhood associations, businesses, faith-based leaders, community agencies and university researchers to develop a multi-faceted approach to promote physical activity and healthy eating toward the general goal of preventing and reducing childhood obesity among children in Grand Rapids, MI, USA.</p> <p>Methods/design</p> <p>There are four overall components to Project FIT: school, community, social marketing, and school staff wellness - all that focus on: 1) increasing access to safe and affordable physical activity and nutrition education opportunities in the schools and surrounding neighborhoods; 2) improving the affordability and availability of nutritious food in the neighborhoods surrounding the schools; 3) improving the knowledge, self-efficacy, attitudes and behaviors regarding nutrition and physical activity among school staff, parents and students; 4) impacting the 'culture' of the schools and neighborhoods to incorporate healthful values; and 5) encouraging dialogue among all community partners to leverage existing programs and introduce new ones.</p> <p>Discussion</p> <p>At baseline, there was generally low physical activity (70% do not meet recommendation of 60 minutes per day), excessive screen time (75% do not meet recommendation of < 2 hours per day), and low intake of vegetables and whole grains and high intake of sugar-sweetened beverages, French fries and chips and desserts as well as a high prevalence of overweight and obesity (48.5% including 6% with severe obesity) among low income, primarily Hispanic and African American 3^rd-5^thgrade children (n = 403).</p> <p>Trial registration</p> <p><b>ClinicalTrials.gov <a href="http://www.clinicaltrials.gov/ct2/show/NCT01385046">NCT01385046</a></b></p

Pandemic gardening: A narrative review, vignettes and implications for future research

There is a significant amount of evidence highlighting the health, wellbeing and social benefits of gardening during previous periods of crises. These benefits were also evident during the COVID-19 pandemic. This paper presents a narrative review exploring gardening during the early stages of the COVID-19 pandemic to understand the different forms of gardening that took place during this crisis and key elements of this activity. Research about gardening during the pandemic focused on food (in)security and disrupted food systems, the health and wellbeing benefits of gardening, and the social dimensions of gardening. We offer three vignettes of our own research to highlight key insights from local, national and international perspectives of gardening during the pandemic. The paper’s conclusion outlines how researchers, policy makers and public health practitioners can harness what has been learned from gardening during the pandemic to ensure these benefits are more widely available and do not exacerbate already entrenched health inequalities in society

Pandemic gardening: A narrative review, vignettes and implications for future research

There is a significant amount of evidence highlighting the health, wellbeing and social benefits of gardening during previous periods of crises. These benefits were also evident during the COVID-19 pandemic. This paper presents a narrative review exploring gardening during the early stages of the COVID-19 pandemic to understand the different forms of gardening that took place during this crisis and key elements of this activity. Research about gardening during the pandemic focused on food (in)security and disrupted food systems, the health and wellbeing benefits of gardening, and the social dimensions of gardening. We offer three vignettes of our own research to highlight key insights from local, national and international perspectives of gardening during the pandemic. The paper’s conclusion outlines how researchers, policy makers and public health practitioners can harness what has been learned from gardening during the pandemic to ensure these benefits are more widely available and do not exacerbate already entrenched health inequalities in society

“To me, it's just natural to be in the garden”: a multi-site investigation of new community gardener motivation using Self-Determination Theory

International audienceWe compare interviews with 30 new community gardeners in Denver, Colorado and Montpellier, France, using Self-determination theory, a general theory of motivation, to determine how new community gardeners may or may not have felt motivated based on psychological needs of autonomy, competence, and relatedness. Relatedness as a motivational feature carried through the interview data at both sites. Participants’ success or failure to relate to other gardeners was a major influence for how autonomous and competent as a community gardener they expressed feeling. As the evidence grows that community gardening is beneficial for health and wellbeing, our findings are critical to understanding how community gardening could serve as a health promotion strategy. With the presence of ongoing, friendly support from others, more individuals may adhere to this socially connective, nature-based practice